Tranquilized Analgesia Nasal Endotracheal Intubation Technique

Clinical experience has shown that nasal endotracheal intubation is often used for patients who have difficulty with oral intubation, need to maintain tracheal intubation post-surgery or require clinical treatment of the oropharynx. This article mainly discusses the use of sedation and analgesia for nasal endotracheal intubation.

Classification of nasal endotracheal intubation

Nasal endotracheal intubation is clinically classified as either visual or blind insertion techniques. Visual insertion is divided into complete visual intubation and partial visual intubation. Complete visual intubation is typically performed using a bronchoscope for guidance throughout the alignment of the insertion. Partial visual intubation typically entails blindly inserting a guide wire through the nasal cavity and into the pharynx followed by exposing the vocal cords via an endoscope and placing the tube into the trachea. The choice between techniques typically hinges on the patient's needs and conditions, as advised by the attending physician. Endotracheal tube suppliers must remain vigilant, ensuring that healthcare facilities have access to the appropriate tubes required for nasal endotracheal intubation.

All three types of nasal endotracheal intubation require adequate sedation and analgesia. Bronchoscope-guided intubation also requires the use of drugs to inhibit airway secretions, such as atropine or glycopyrrolate. The other two nasal endotracheal intubation techniques do not have particularly high demands on the removal of airway secretions, although the bronchoscope-guided intubation requires slightly higher skills in operation.

Anesthesia and operation for nasal endotracheal intubation

During anesthesia and operations involving nasal endotracheal intubation, the utilization of a disposable endotracheal tube can help ensure patient safety. After the patient enters the operating room, they are typically asked to extend their tongue out, after which 2-3ml of 2% lidocaine is sprayed along the whole tongue surface naturally flowing into the tongue root pharynx. The patient is then instructed to hold the anesthetic in his throat for about 5 minutes before swallowing. Then, intravenous sufentanil 10-20ug is administered, followed by an infusion of dexmedetomidine at a loading dose of 0.4ug/kg for 5-10 minutes. Small doses of remifentanil can also be infused simultaneously until intubation is complete. For bronchoscope-guided intubation, atropine or glycopyrrolate (0.01mg/kg) is also given through an intravenous infusion. After the patient swallows the lidocaine, 2-3ml of 2% lidocaine is injected into the vocal cords through the laryngoscope or is injected via puncture through the cricothyroid membrane. The latter is more effective. At this point, episodic sedation prior to nasal endotracheal intubation was essentially complete.

After removing the nasal swabs, any phlegm in the oropharynx is initially removed. For bronchoscope-guided intubation, the scope is inserted deep into the lower nostril and gradually enters the trachea via the middle of the airway. For the other two methods, the catheter is inserted through an adult suction tube, and the catheter is inserted through the nasal cavity. If there is any resistance while inserting the catheter, it can be slowly rotated to place it through the narrow passages both anteriorly and posteriorly, and then placed into the pharynx.

After the tip of the catheter enters the pharynx, the vocal cords are exposed by inserting the laryngoscope through the mouth, and the catheter can be visually placed into the trachea via the catheter-guided pouch, or with the aid of a catheter clamp.

In conclusion, the above-mentioned intubation techniques can be selected depending on the patient's condition, the surgical situation, personal experience, equipment, medication and personnel available in the department.